ECX - Standard Chemotherapy

ECX - Epirubicin, Cisplatin, Capecitabine (Xeloda)  - is the standard chemotherapy treatment being offered for this condition.  I will receive it if I stay outside the ST03 Clinical Trial.

In this post I will be explaining the outline of the administration and side effects.  It may well be of interest to the medics amongst you but is also useful to help me remember the information for use in conversation with my medical team.

Before going into detail it is worth mentioning that if you pick up a packet of paracetomol you will find a whole list of cautions and possible side effects so many of the things in this document are unlikely to happen.  The particular combinantion of drugs does make it likely that I will temporarily lose my hair, so that means that my mates who are receding will have one up on me for a while.  The only side effects that concern me are the possibility of hearing damage (particularly because I have suffered recurring ear infections and tinnitus) and the possibility of anaemia, because it was severe anaemia that led to my diagnosis.  Although my anaemia has easied by haemoglobin is still below regular levels.

In an earlier post I provided links to information about each of the three drugs.  Here is how they are administered.  Remember that I will undergo a minimum of 3 cycles of chemotherapy before surgery, each cycle lasting 3 weeks.

Epirubicin is given as an injection through a cannula (thin tube) in the arm.  The injection is repeated every three weeks.

Cisplatin  is given as an intravenous infusion (drip) through a cannula in the arm.  The process takes six hours, which include an hour of intravenous fluids before and after the drug to protect the kidneys.  It is administered once every three weeks.  There is an overnight stay (for at least the first application) to allow monitoring to take place.

Capecitabine is given in tablet form. The tablets are taken twice a day for 21 consecutive days following each epirubicin and cisplatin.

Likely Side Effects of the Combined Therapy

Sickness: For the first few days there may be nausea or vomiting.  This can be controlled with anti-emetics (anti sickness drugs). The anti sickness drugs could cause constipation.

Hair Loss: This type of chemotherapy usually causes loss of hair, but the hair grows back once the treatment stops.

Effects on blood counts: The blood contains three types of cells: red cells, white cells and platelets.  All of these can be temporarily lowered by chemotherapy.

Low white cells: can lead to an increased risk of infection.  Antibiotics may be needed to help fight the infection.  The white cell count is monitored before each cycle of treatment to ensure that it is safe to continue.

Low platelet count:  can lead to an increased risk of bruising or bleeding.

Low red cells: can cause anaemia and can cause tiredness and breathlessness.  A blood transfusion may be required.

I have already documented that my condition was discovered largely due to it causing me to be severely anaemic (at transfusion levels), so this is obviously something that I should keep an eye on.

Less common side effects

Rash: can cause a red rash on the skin while taking capecitabine, particularly on the hands and feet, or in areas where tight fitting clothing has been worn (e.g. belts).  In rare cases it can cause temporary difficulties in walking.  The rash stops once the drug is stopped.

Diarrhoea: caused in about 50% of patients.  It can be controlled with other drugs or by reducing the levels of chemotherapy.

Sore mouth: can be caused by capecitabine (including ulceration and gum shrinking)

Chest Pain: can cause chest pains and palpitations.  There can be a number of causes of the chest pain but it is possible that it is being caused by a temporary narrowing of the blood vessels supplying the heart (angina which may lead to a heart attack)

Hearing Loss:  cisplatin may cause damage to hearing or worsen any pre-existing hearing impairment.  Symptom include difficulty hearing and tinnitus.  This is something to watch out for as it was recurrent ear-infections that originally took me to the doctor last summer.  I have suffered temporary but fairly lengthy periods of tinnitus (up to 3 months).  On one occasion of about 2 months I suffered what I considered to be excruciating tinnitus.  At night time (i.e. when there was not any other noise distraction) it was the equivalent of someone standing over me and constantly screaming in my ear.

The Risk of Blood Clots Associated with Cancer and Chemotherapy
There's an increased risk of having blood clots and deep vein thrombosis when you have cancer.  The risk is increased by chemotherapy

Effect of chemotherapy on fertility and contraception
Chemotherapy can damage the ovaries and testes.  This can result in temporary of permanent infertility and can cause premature menopause (though I don't think it will affect me :-) )

It is important not to conceive during chemotherapy due to possible effects on the foetus.